He isn’t charging you to tell you he can’t do the surgery. He is charging you to examine and evaluate you. He determined from his examination that he could not do the surgery. He should still be paid for his services. If you have a beef it’s with the referring physician.
Where is the US are you located? Trades people and professionals absolutely charge for their time and travel even if they can’t fix the problem.
Exceptions are
(1) If you are getting a contractor’s or service providers bid or opinion on a largish building job, repair, remodel, addition or addition that’s generally not charged
(2) A professional (Doctor, lawyer, architect etc) is specifically offering free consults as way to build business. Many people starting out do this.
, but if you are calling a tradesperson (electrician, plumber, etc) to come out to our residence for a specific repair issue that’s time they could be spending elsewhere and it will be billed. Same for professionals office time.
It sounds like you learned that the condition you have requires a more complicated procedure than your regular doctor thought. This may be very valuable information, however annoying it is to find out in this way.
There are a lot of trades people and professionals who will travel a reasonable distance to evaluate a problem or provide an estimate, or see you in their office for a consultation without charging you, but professionals like doctors and lawyers usually bill for all of their time. They’re not providing the service looking to sign up a new customer or bid against competitors, they’re providing professional services.
He spent some time and used his expertise to evaluate your situation. He did do something. Doctoring isn’t all cutting people open. He deserves that $$$.
I’d pay.
I’m not a big user of medical services but I did require surgery earlier this year. My GP referred me to a surgeon she thought would be most appropriate. Had that surgeon said she felt my needs were more complex than she could manage and wanted to refer me on to a more specialised person, I’d have been glad to be in the most competent hands.
I wouldn’t expect a plumber to bill me if he came over and told me “I don’t have the tools/I’m not good enough to fix this problem, please call another plumber”.
Sure, he spent time to come over but he didn’t provide any kind of service to me. I’m not sure what I should pay him for. And I’m pretty sure very few plumbers would dare to present a bill in such a situation.
Last week a mechanic came over to fix my mother’s car, saw he couldn’t, advised her to have it hauled to the car dealer, and most definitely didn’t bill her.
And the difference between a plumber saying “I don’t know how to fix it, ask someone else” and a lawyer/doctor saying the same is? What justifies that the second will bill you and not the first?
Is it that the doctor doesn’t do the surgery at all, or doesn’t do the type of surgery your primary is recommending, or that he won’t do the surgery on you? That would alter my answer considerably.
If the referring doctor sent you to, for example, an orthopedic surgeon for a consult for vascular surgery, then that’s just dumb, and I’d be calling the referring physician to complain and at least attempt to pressure them to relieve you of this fee.
If the referring doctor sent you to a urologist for a DaVinci robotic assisted prostatectomy, and that urologist doesn’t do DaVinci ever, but agrees that a DaVinci would be better for you, then that’s enough of a grey area where I think you should pay, but feel a bit grumbly about it, and call the referring physician to complain. Prostatectomy is within the scope of practice of a urologist, but not every urologist does them with DaVinci. The referring physician really ought to have had his staff call the specialist’s office to make sure that they do the specialty surgery they’re referring you for.
If the specialist does to the procedure you were referred for, but determined that due to your weight, lung function, blood sugar control or other personal risk factors, and based on his professional experience and competence with high risk surgeries, he’s not going to do that procedure on you, then he’s made a skilled assessment and deserves to be paid, full stop. He’s used his professional training and experience to benefit you. You may want to, as a courtesy, let the referring physician know that his referral isn’t a good referral for complex cases, but that’s another matter aside from payment.
I had a case today where I was sent out to evaluate a client for home health services. I needed to do an assessment before I could, using my professional experience and my newly gathered knowledge of the specifics of the case, determine that this person needed the services of a nursing home, not a home health nurse. Now, should that doctor have referred her to a nursing home instead of a home health nurse? Well, maybe, but that doctor didn’t know, and had no way of knowing, exactly what the home situation was and that what the patient needed couldn’t be safely addressed at her home. That was WHY he sent me, to find out if I could do the job at home. Many people with her diagnoses can safely be treated at home, but the particulars of her case, a lack of caregiver support, and the physical layout of her home create a special situation for her where it isn’t a good idea for her case in particular. It required the knowledge I have as a professional registered nurse to assess the patient and her environment and know when I’m not what she needs, and the skills of a nurse to provide patient and family education about why they didn’t need me, they needed a nursing home. I worked just as hard for that hour as I do any other hour, using skills I learned in nursing school and working as a nurse. Do I not deserve to be compensated for that hour of nursing as much as any other hour of nursing? Medicare says yes, I should be compensated, as long as I complete and submit a comprehensive assessment for that one visit. If I’ve done a comprehensive assessment, I’ve been a nurse, and that’s a Skilled Nursing Visit.
Many plumbers ***choose ***to advertise free estimates and no trip fees, as do some doctors for some procedures (LASIX, as mentioned being a big one that tends to offer free consults.) That doesn’t mean you should assume your plumber is offering a free estimate, unless it’s mentioned on his advertising. And people, on average, are more complex and varied than plumbing. There’s more chance that a plumber will be able to help with your plumbing issue because plumbing doesn’t change a whole lot from building to building. Doctors aren’t like plumbers because people aren’t like plumbing.
(But having said all that, I’ll also add: Universal Single Payer health care would fix this problem. If I was paid a salary independent of my visit count, if a doctor’s practice was paid a salary independent of procedural coding, then we wouldn’t be having this conversation. Then we could all do consultations for free at the point of service and still feed our families.)
A few other people have responded it but I’ll throw my 2 cents in as well. I deal with it situations all the time where plumbers or electricians can’t solve the problem and they refer their customer to me to solve the problem.
I’m a well driller/pump installer. In my region my trade is a specialty trade separate from plumbing and operates off a different license, there are different aspects where our licenses overlap
When people find they have no running water a lot of times their first call is to a plumber. A plumber will go out and check it out. Sometimes it could be entirely a plumbing issue. Sometimes it’s a pumping equipment issue a plumber is capable of fixing. Sometimes they find it’s a problem with the pumping equipment they can not resolve. In all those instances the plumber is going to bill the customer for their time.
Other members of my trade will also charge for a site visit after finding the problem is more complex then they can handle and refer the customer to me. Sometimes they don’t know where the well is and refer me because I’ll either have the information or am more capable of locating it, sometimes it’s because they lack specific equipment required to do the job, sometimes it’s because they lack the knowledge of a specific system design, sometimes it’s because they can’t do the job in the time frame required, sometimes it’s because the customers an asshole and they don’t want to deal with them.
I was referred to an ENT doctor by my GP for a minor skin procedure near my throat. The ENT briefly looked in my ears then informed me that the GP or dermatologist should take care of the skin thing. I was billed $400 due to classification as a new patient visit.
Yes, it’s acceptable for him to bill. Why would it not be?
Did he not bill your insurance?
He went to college and med school for 8 years, residency and more training. He has an office that he pays rent for, staff, phones, the electric bill, plus whatever else it takes to keep up the office.
Now you wish to walk into his office, use his facilities, and more important use his years of training and expertise in a specific subject to seek his advice and you think this is free to you ?
I can understand why people don’t view assessment as a “something” that “the doctor did”. So in their perception, the doctor didn’t “do anything,” so why should he get paid?
It’s like most of the stuff that nurses do…patients don’t ever actually see it. Patients see the tip of the iceberg of what our jobs actually involve, and think they know what nurses do. Most of my nursing is going on inside my head. What I do with my hands in the view of the patient is the least part of my job.
Fair question procedurally, but I’d argue irrelevant ethically and practically. I’m rather tired of people treating health care costs paid for by insurance as not counting. (I’m looking at you, Martin Shkreli, most hated pharmaceutical CEO.) When fees are paid by insurance, you’re paying them, I’m paying them, we’re all paying them. We *should *be doing our part to prevent fraudulent and excessive billing to insurance companies, not to protect the evil insurance industry, but because at the end of the day, the insurance company doesn’t pay jack…we do. The insurance company makes a profit by handing our money to the providers.
That certainly isn’t true. People who sell their time charge when you use their time. I have paid plumbers to come out to the house, examine the problem and say they could fix it but they are so busy they can’t take the job. I didn’t like it, but they made the trip and were honest about the conclusion.
I have heard of lawyers sending bills to cover the time it took to make an appointment to come see the lawyer. Not saying it is common, but it does happen.
One way or the other you pay your share of their time. If the ‘initial visit’ is free, the subsequent visits are more expensive.
If you call Roto-rooter and they send guys out, they will charge you for sending the guys out unless it’s some special deal. If you take a car to a mechanic, he’ll charge you for diagnosing it even if he can’t find the problem, can’t fix the problem, or has to refer you somewhere else. Pretty much every ‘come to your house to fix stuff’ service will charge some base price for showing up, unless it’s a bigger job and they’re showing up to give an estimate.
I’ve had it happen to me before, it’s not even something exceptional.
The exception is a big exception, because sometimes it’s hard to distinguish between a project and a necessary repair. If I want the plumber to come out and quote replacing my properly working zinc pipe with copper pipe, that’s not something I would pay for (and it’s not a “big” project). Small stuff (replacing my needle valve with a real valve) can be quoted over the phone. Sometimes it’s grey.
$60? That’s between a third and a quarter of a normal office visit. So you got a discount.
Reminds me of old joke: expensive complicated machine breaks down; expert called in to fix it. Tightened one screw. Owner complained about $200 bill. Got an itemized statement: Tightened screw: $5. Knowing which screw needed it: $195
Nailed it, with one exception: if the referring physician sent you to the wrong specialty, that’s also on the new consultant. His office should be asking the patient what they’re coming in for before scheduling the appointment. Apart from anything else, I know many practices get a lot of patients who are scheduled to see “Dr. John Smith, the dermatologist” but accidentally call the office of “Dr. John Smith, the ENT” or whatever.
I am assuming that you would not expect a physician to bill if he doesn’t do the procedure at all and his office scheduled the appointment even though the patient specifically mentioned he was coming in for that procedure.